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Managing heart failure with reduced ejection fraction merged with myocardial infarction with non-obstructive coronary

So Ikebe1, Masahiro Yamamoto1, Masanobu Ishii1,2

  • 1Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.

European Heart Journal. Case Reports
|October 25, 2024
PubMed

Insights

Myocardial infarction with non-obstructive coronary arteries (MINOCA) can be treated with calcium channel blockers (CCBs) for coronary spastic angina (CSA/VSA). This approach improved ejection fraction and heart failure symptoms in a patient with HFrEF.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Myocardial infarction with non-obstructive coronary arteries (MINOCA) is increasingly recognized.
  • Coronary spastic angina (CSA/VSA) is primarily treated with calcium channel blockers (CCBs), while beta-blockers may not always be effective.
  • Beta-blockers are crucial for coronary microvascular dysfunction and heart failure with reduced ejection fraction (HFrEF).

Observation:

  • An 83-year-old female presented with worsening heart failure and chest pain at rest, despite no obstructive coronary artery disease.
  • Functional coronary angiography revealed epicardial coronary spasm, leading to a diagnosis of CSA/VSA-induced myocardial injury.
  • Treatment with dihydropyridine CCBs was initiated.

Findings:

  • The patient experienced resolution of chest pain and improvement in heart failure symptoms (NYHA class III to II).
  • Biomarkers of heart failure (BNP) significantly decreased.
  • Ejection fraction improved substantially from 32% to 62.6%.

Implications:

  • CCBs, though not standard for HFrEF, can be beneficial for HFrEF patients with concomitant CSA/VSA.
  • Comprehensive diagnostic evaluation and tailored treatment are vital for managing complex cardiac conditions.
  • This case highlights a potential therapeutic strategy for improving outcomes in patients with MINOCA and HFrEF.
Abstract

Keywords:
CSAEjection fractionFunctional coronary angiographyHeart failureMINOCAVSA

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